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Systematic Review Question: What is the relationship between low carbohydrate diets and body weight?

Summary of Evidencce

Body Weight
• Twenty-eight articles examined the relationship between low-carbohydrate diets and body weight, including 26 randomized controlled trials, 1 non-randomized
controlled trial, and 1 prospective cohort study.
o The intervention studies were conducted in the US (10), Australia (4), Denmark (2), Israel (2), New Zealand (2), Canada, Germany, Iran, the Netherlands,
Norway, Spain, and in multiple European sites. The prospective cohort study was conducted in the US.
o One study was conducted in children, and 27 studies were conducted in adults.

• The 2010 DGAC examine the relationship between macronutrient proportion and various body weight outcomes. Below is a brief summary of the questions they
addressed, along with the conclusion statements and grades:
o What is the optimal proportion of dietary fat, carbohydrate, and protein to lose weight if overweight or obese? (DGAC 2010)
 There is strong and consistent evidence that when calorie intake is controlled, macronutrient proportion of the diet is not related to losing weight.
Grade: Strong
o What is the optimal proportion of dietary fat, carbohydrate and protein to avoid regain in weight-reduced persons? (DGAC 2010)
 A moderate body of evidence provides no data to suggest that any one macronutrient is more effective than any other for avoiding weight re-gain in
weight reduced persons. Grade: Moderate
o Are low-carbohydrate (less than 45%) hypocaloric diets safe and effective for long-term (more than six months) weight loss or maintenance? (DGAC 2010)
 A moderate body of evidence demonstrates that diets with less than 45% of calories as carbohydrates are not more successful for long-term weight
loss (12 months). There is also some evidence that they may be less safe. In shorter-term studies, low-calorie, high-protein diets may result in greater
weight loss, but these differences are not sustained over time. Grade: Moderate
o Are high-protein (>35%) hypocaloric diets safe and effective for long term (more than six months) weight loss or maintenance? (DGAC 2010)
 A moderate amount of evidence demonstrates that intake of dietary patterns with less than 45% calories from carbohydrate or more than 35% calories
from protein are not more effective than other diets for weight loss or weight maintenance, are difficult to maintain over the long term, and may be less
safe. Grade: Moderate

Study Intervention Results


Ankarfeldt, 2014 • Low protein: 50% CHO, 17% PRO, 29% FAT No differences in weight change between groups.
• High protein: 44% CHO, 20% PRO, 32% FAT

Duration: 6 months
Archer, 2003 • High CHO: 58% CHO, 16% PRO, 26% FAT No differences in weight or waist circumference change between groups.

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• High MUFA: 45% CHO, 15% PRO, 40% FAT

Duration: 6-7 weeks


Azadbakht, 2013 • High protein: 45% CHO, 25% PRO, 30% FAT No differences in weight, BMI, or waist circumference change between groups.
• High CRP sensitivity: 55% CHO, 15% PRO, 30%
FAT

Duration: 3 months
Bazzano, 2014 • Low CHO: 34% CHO, 24% PRO, 41% FAT Body weight and fat mass decreased more in the low-carb group compared to
• Low Fat: 54% CHO, 19% PRO, 30% FAT the low-fat group (P<0.002, P=0.011).

Duration: 12 months No differences in waist circumference.


Bray, 2012 • High fat, high protein: 35% CHO, 25% PRO, 40% No differences in weight, BMI, or body fat change between groups.
FAT
• High fat, low proten: 45% CHO, 15% PRO, 40% FAT
• Low fat, high protein: 55% CHO, 25% PRO, 20% FAT
• Low fat, low protein: 65% CHO, 15% PRO, 20% FAT

Duration: 6 months
de Jonge, 2012 • High fat, high protein: 35% CHO, 25% PRO, 40% No differences in weight, BMI, or waist circumference change between groups.
FAT
• High fat, low proten: 45% CHO, 15% PRO, 40% FAT
• Low fat, high protein: 55% CHO, 25% PRO, 20% FAT
• Low fat, low protein: 65% CHO, 15% PRO, 20% FAT

Duration: 24 months
de Luis, 2007 • Low fat: 52% CHO, 20% PRO, 27% FAT No differences in weight loss between groups.
• Low carb: 38% CHO, 26% PRO, 36% FAT

Duration: 3 months
Duckworth, 2009 • Standard diet: 50-55% CHO, 15% PRO,30-35 % FAT No differences in weight, BMI, body fat, fat ass, or waist circumference change
• High protein: 40-45% CHO, 25% PRO, 30-35% FAT between groups.

Duration: 8 weeks, **children


Due, 2008 • High MUFA: 43% CHO, 15% PRO, 38% FAT No differences between groups in weight, BMI, fat mass, and waist/hip
• Low fat: 58% CHO, 16% PRO, 24% FAT circumference change.
• Control: 50% CHO, 16% PRO, 32% FAT

Duration: 6 months

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Ebbeling, 2007 • Low fat: 55% CHO, 25% PRO, 20% FAT No differences between body weight or body fat change between groups.
• Low GL: 40% CHO, 25% PRO, 35% FAT

Duration: 18 months
Eckel, 2006 • High fat: 30% CHO, 20% PRO, 50% FAT High carb diet resulted in higher CHO balance, which was related to gaining less
• High carb: 55% CHO, 20% PRO, 25% FAT fat mass, less body fat, and less weight.

Duration: 15 days
Frisch, 2009 • Low fat: 50% CHO, 17% PRO, 30% FAT No differences in weight, fat mass, BMI, or waist circumference change between
• Low carb: 44% CHO, 19% PRO, 34% FAT groups.

Duration: 12 months
Gardner, 2007 • Atkins: 35% CHO, 21% PRO, 44% FAT Subjects on the Atkins diet lost more weight than those on the Zone diet
• Zone: 45% CHO, 20% PRO, 35% FAT (P<0.05), but there were no other differences in weight change between groups.
• LEARN: 47% CHO, 19% PRO, 33% FAT
• Ornish: 52% CHO, 18% PRO, 30% FAT

Duration: 12 months
Greenberg, 2009 • Low fat: 50% CHO, 24% PRO, 28% FAT No differences in weight loss between groups.
• Mediterranean: 45% CHO, 24% PRO, 33% FAT
• Low carb: 38% CHO,26% PRO, 36% FAT

Duration: 24 months
Heggen, 2012 • Low fat: 45% CHO, 19% PRO, 32% FAT No differences in weight loss between groups.
• Low GL: 37% CHO, 21% PRO, 37% FAT

Duration: 3 months
Keogh, 2008 • Low Carb: 5% CHO, 35% PRO, 56% FAT Weight loss and decrease in BMI were greater in the low carb group compared to
• High carb: 47% CHO, 24% PRO, 28% FAT the high carb group (by ~1 lb over 8 weeks, P<0.01)

Duration: 8 weeks
Krauss, 2008 • 54% carb: 54% CHO, 16% PRO, 30% FAT No differences in weight loss between groups.
• 39% carb: 39% CHO, 29% PRO, 31% FAT
• 26% carb: % CHO, 29% PRO, 46% FAT
• 26% carb, high SFA: 26% CHO, 29% PRO, 45% FAT

Duration: 9 weeks
Kreider, 2011 • High carb: 51% CHO, 19% PRO, 31% FAT No differences in weight loss or change in fat mass or BMI between groups.

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• High protein: 37% CHO, 28% PRO, 36% FAT

Duration: 10 weeks
McAuley, 2005 • High carb: 45% CHO, 21% PRO, 28% FAT No differences in weight loss between groups.
• Atkins: 26% CHO, 24% PRO, 47% FAT
• Zone: 35% CHO, 26% PRO, 35% FAT

Duration: 24 weeks
McMillan-Price, 2006 • Diet 1: 60% CHO, 18% PRO, 19% FAT No differences in weight loss between groups. Fat mass decreased more among
• Diet 2: 56% CHO, 19% PRO, 22% FAT those on diets 2 and 3 compared to diet 1.
• Diet 3: 42% CHO, 28% PRO, 27% FAT
• Diet 4: 40% CHO, 26% PRO, 29% FAT

Duration: 12 weeks
Noakes, 2005 • High protein: 44% CHO, 31% PRO, 22% FAT No differences in weight loss between groups.
• High carb: 61% CHO, 18% PRO, 20% FAT

Duration: 12 weeks
Phelan, 2007 • Low carb: 17% CHO, 20% PRO, 59% FAT No differences in weight loss/regain between groups after 3 years.
• Others: 47% CHO, 19% PRO, 33% FAT

Duration: 3 years, prospective cohort study


Sacks, 2009 • Low fat,average pro: 53% CHO, 20% PRO, 27% FAT No differences in weight loss/regain between groups.
• Low fat,high protein: 51% CHO, 21% PRO, 28% FAT
• High fat,average pro:47% CHO, 20% PRO, 33% FAT
• High fat, high protein:43% CHO, 21% PRO, 35% FAT

Duration: 2 years
Shai, 2008 • Low fat: 51% CHO, 19% PRO,30 % FAT No differences in weight loss between groups.
• Med: 50% CHO, 19% PRO, 33% FAT
• Low carb: 40% CHO, 22% PRO, 39% FAT

Duration: 2 years
Soenen, 2012 • Normal carb, pro: 35% CHO, 30% PRO, 35% FAT No differences in weight loss between groups.
• Normal pro, low carb: 5% CHO, 30% PRO, 65% FAT
• Normal carb, high pro: 35% CHO, 60% PRO, 5%
FAT
• High pro, low carb: 5% CHO, 60% PRO, 35% FAT

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Duration: 12 months
Tay, 2008 • Very low carb: 4% CHO, 35% PRO, 61% FAT No differences in weight loss between groups.
• High carb: 46% CHO, 24% PRO, 30% FAT

Duration: 24 weeks
Te Morenga, 2011 • High protein: 40% CHO, 28% PRO, 29% FAT Subjects on the high protein lost more weight and body fat than those on the
• High carb: 51% CHO, 22% PRO, 23% FAT high carb diet (p=0.029, p<0.005).

Duration: 8 weeks
Tierney, 2011 • High fat, SFA: 41% CHO, 17% PRO, 38% FAT Body weight was reduced (~1%) after the low fat diets compared to the high fat
• High fat, MUFA: 42% CHO, 17% PRO, 38% FAT diets (P<0.05). BMI and waist circumference change did not differ between
• Low fat, high oleic sunflower oil supplement: 49% groups.
CHO, 19% PRO, 28% FAT
• Low fat, VLC n-3 PUFA supplement: 50% CHO, 18%
PRO, 28% FAT

Duration: 12 weeks

REFERENCES

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